Correction of the Cavo-varus foot using Orthosolutions Titanium screws & Ultos plate. surgical technique
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Pes Cavovarus describes a deformity of the foot characterised by a high arch, and a plantar-flexed 1st ray. Whilst some subtle deformities may represent a physiological normal variant, pes cavovarus is often associated with neurological disorders; the commonest being Charcot-Marie-Tooth disease (Hereditary sensori-motor neuropathy).
The deformity progresses as a result of asymmetrical denervation of the flexor and extensor musculature. The power of the Gastocnemius-Soleus, Tibialis posterior and Peroneus Longus muscles are usually preserved relative to the Peroneus brevis, tibialis anterior and intrinsic foot muscles, which are demonstrably weak.
The driver for the deformity is usually a plantar flexion of the 1st metatarsal. In order to engage the ground, the rest of the forefoot compensates by an obligatory supination. The effect of the forefoot supination is (via the forefoot-hindfoot couple) an inversion of the hindfoot, producing the characteristic varus heel. The concept of contracture or tightness of the plantar fascia remains controversial.
In those patients with flexible deformity, joint preserving surgery can be considered and such a case is detailed here treated with osteotomies and tendon transfers.
Author: Mr Nick Cullen FRCS (Tr & Orth)
Institution: The Royal National Orthopaedic Hospital , Stanmore ,London ,UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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